Occupational Health Management | Complete guide on OHM

Occupational Health Management | Complete guide on OHM

Several times we get confused with the terms "Health" and "Occupational health", are the same? Here are some definitions of health;

 “Health is absence of disease or infirmity”

“the state of being free from illness or injury”

“state of complete physical, mental, and social well-being”

“merely the absence of disease or infirmity”

In this article, we are concerned with humans and discuss the different terms used in relation to human health, in particular occupational health, exposure to various hazards in the workplace, the concept of occupational health, the objective and importance of occupational health, occupational health services, the requirements of the occupational health center in the industry, occupational health program and competence of the occupational physician.

What is health?

Health is physical and mental condition of human. Sometime spiritual well-being may be added but it is ultimately part of mental health. So basically, health has two parameters i.e. physical and mental. We cannot separate out physical health from mental health completely as they are interconnected and interacted, but we can say physical health is state/condition of physical body fitness and absence of diseases and any other physical condition which prevent him to do normal work.

Physical health can be affected by lifestyle, hormonal changes, genetic disorder, our diet, type of physical activities, etc.  

Metal health is related to behavior, intellectual, social and emotional well-being. It may also be affected by genetic disorder, social relation, stress, nature of thinking, social media, other psychological exposure hazards. Sometimes we can say absence of mental disorder is metal health.

As physical and mental health are interrelated and interacted with each other, physical health may affect mental health and vice-versa.

What is occupational health?

World Health Organization (WHO) defined the occupational health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

Albeit word related occupational health is the advancement and support of the most elevated level of physical, mental and social well-being of workers/employees in all occupations, maintaining a strategic distance from well-being gaps, overseeing risk and adjusting work to individuals and individuals their work.

Occupational health is physical and mental condition of human related to his work activity and freedom from illness or diseases arising from their nature of job or exposure of work related physical, chemical, biological psychological and mechanical hazards.

Objective of occupational health

The main objective of occupational health is to protect and promote the health of worker/employees by continuous process of identification, evaluation and controlling the exposure of health hazards at the source to prevent occupational diseases by their working conditions at work.

Another objective of occupational health is assurance of healthy work environment and enhancement of worker’s social well-being including professional and social development at their work.

Occupational health focuses on the physical and mental well-being of employees/worker in the workplace and aim is to prevent work-related ill-health/ diseases by setting suitable disease prevention program and assuring healthy work environment.

Importance of occupational health

The health of workers has several determining factors, including risk factors at work that cause cancer, accidents, musculoskeletal disorders, respiratory disorders, hearing loss, circulatory disorders, stress-related disorders and communicable and other diseases.

Occupational health concentrates relationship between work and health and prevent from ill-health.

A person's health can affect their work, either favorably through higher levels of commitment and performance, or negatively through higher levels of absenteeism and presentism. Likewise, the work of an employee can affect his health, either harm, cause occupational diseases, or, advantageously, generate a virtuous cycle of better performance and well-being.

Occupational health hazards

Occupational Health Management in workplace

Occupational health hazard is a source or a situation or condition likely to cause harm to human in terms of physical, mental or social well-being arising from their working environment or a combination.

Health hazard identification, evaluation and controlling is the foremost part of occupational health management to prevent occupational diseases.

There are five main occupational health hazards in workplace

1. Physical occupational health hazard

Physical hazards are noise, inadequate illumination, extreme vibration or continuous exposure to vibration, extreme temperature (both hot or cold), ionizing radiation or non-ionizing radiation.

2. Chemical occupational health hazard

It may include exposure of toxic chemicals or irritant in the form of dust, mist, vapour, gas, fumes, solid or liquid. The exposure may be through direct contact with skin, inhalation or ingestion.

3. Biological occupational health hazard

It includes exposure to viruses, bacteria and fungi through direct contact with skin, inhalation or ingestion and may cause acute of chronic infection or diseases.

4. Psychological occupational health hazard

Psychological hazards include lack of job satisfaction, insecurity, poor interpersonal relations, work pressure, stress, ambiguity. Psychological & behavioral changes including hostility, aggressiveness, anxiety, depression, alcoholism, drug addiction, sickness absenteeism

5. Mechanical occupational health hazard

This type of hazard is generated due to poorly designed workplace or work task. Repetitive work actions, unsafe manual handling of material including lifting, holding, carrying, lowering, loading, walking, etc may create occupational ergonomic hazards.

Occupational health diseases/ ill-health and their causes

As per OHSAS-18001, ill-health or occupational disease is Identifiable, adverse physical or mental condition arising from and / or made worse by a work activity and / or work-related situation.

An occupational illness may cause by exposure of different type of occupational health hazards.

Occupational illness normally develops over a period because of workplace conditions and work environment. 

OH hazard type	Cause/Exposure	ill-health
Physical	Exposure to Heat	Exhaustion, Syncope, muscle cramps, burns, Prickly, Dehydration, heat stress, Heat stroke, etc
	Exposure to cold	Frost bite, Hypothermia, freeze-burn,
	Exposure to light	Occupational Cataract, Illumination
	Exposure to atmospheric pressure	Caisson disease, explosion
	Noise Exposure	Occupational deafness
	Radiation exposure	Cancer, Leukemia, Aplastic anemia
	Contact with electricity	Burns, Shocks, cardiac failure
Chemical	Exposure to metals viz Lead, As, Hg, Cd, Ni , Co	metal poisoning, interfere with metabolic processes, damage due to oxidative stress induced by free radical formation
	Exposure to aromatic hydrocarbons – Benzene, Toluene, Phenol	vascular permeability and edema, ventricular   tachycardia and ventricular fibrillation, euphoria followed by depression, metabolic acidosis, muscle paralysis, aplastic anemia, acute myelogenous leukemia, and multiple myeloma,
	Inhalation of Gases N2, CH4, CO2; CO, H2S, HCN Ammonia, SO2, Cl2	Simple asphyxiants: Chemical asphyxiants  Irritation
Biological	Bacterial Infection	Tetanus, Tuberculosis, Anthrax, Brucellosis (Milkmen), Gonorrhea
	Viral infection	Hepatitis, HIV
	Protozoal & Parasitic	Malaria, Hookworms, Hydatid (Dog-handlers), tapeworms
	Fungal infection	Tinea-infections, Psittacosis, Coccidiomycosis, Ornithosis
Psychological	Psychological hazards include lack of job satisfaction, insecurity, poor interpersonal relations, work pressure, ambiguity. Psychological & behavioral changes including hostility, aggressiveness, anxiety, depression, alcoholism, drug addiction, sickness absenteeism	Psychological disorders like hypertension, headache, body-ache, peptic ulcers, asthma, diabetes, heart disorders.
Mechanical	Ergonomic Disorders	Musculo-skeletal-disorders (MSDs), Cumulative-trauma-Disorders (CTDs)
	Ergonomics	Adjustment of Man & Machine
	User-friendly tools	Tools that reduce stress or problems caused by CTD / MSD).

Occupational health program

Occupational health program is multidisciplinary plan developed for preventing the occupational diseases or illness by continuous monitoring of workplace, early identification, evaluation and controlling the work-related health hazards.

It allows to develop and maintain the employees or workers medical database for continuous monitoring, recognizing the occupational disease, and evaluation for taking decision on further changes required in work environment.

Occupational health program formulated on risk-based analysis and helps organization to identify and comply all applicable legal obligations related to workers health. It allows to identify the training and awareness requirement based on proactive diagnostic through periodic medical examination and workplace monitoring survey.

Occupational health program includes

• Organizational framework with roles and responsibilities of top management, middle management and bottom line including medical physician, safety practitioner, etc.
• Hazard identification, risk assessment and implementation of controls.
• Applicable health care procedures and best practices
• Standard for Pre-employment medical examination, periodic medical examination, first aid record, hygiene survey, workplace monitoring, etc.
• Evaluation for adequacy of occupational health center and number of competent medical physician.
• Similar exposure group Identification at multiple work-site within same premises based on nature of exposure or type of hazard exposure
• Identify the requirement for occupational Health Screening for specific hazard at specific location based on available data.
• Initiate an investigation process for first detection of undesirable Health Effects during health monitoring of workplace sample survey.
• Develop and monitor the occupational exposure data and trends related to occupational diseases.
• To ensure compliance with provincial regulations, it supports management on decision making process regarding employee hiring. 

Occupational health management

Occupational health management system must be developed, implement and maintained to prevent occupational diseases by encouraging safe and healthy working practices and providing healthy work environment.

Occupational health management includes establishing, implementing, maintaining and improving the health policy, organizational framework, health training and education, occupational health hazard identification, risk assessment and assurance of controls to prevent the occupational diseases, different procedures for health promotion and enhancement in social well-being, worker promotional activities and various improvement campaign, addiction prevention programs, pre-employment medical examination, periodic medical examination, hygiene survey, ergonomic survey, exposure monitoring survey, inspections, audits and management reporting and review, etc.

Workplace ergonomic survey and study helps to identify the correct way of performing work and improvement in any work equipment rearrangement. 

Occupational Health Management in workplace

Occupational Health Management in workplace includes;

Suitable and hygienic eating facilities: 

Rest areas where workers are taking a break from work. Such areas should have enough seating and be away from hazardous work areas, allowing workers to remove PPE and relax. There must be provisions for food so that food can be consumed in a hygienic environment. If hot food is not provided at work, basic services can be provided so that employees can prepare their own hot food and drink. Non-smoking facilities should be available to protect workers from second-hand smoke. (Note that smoking in workplaces is tightly regulated by statute

Adequate illumination in workplace:

• Minimum lighting levels must be reached (lux levels); They are usually indicated by the local code of practice or guidelines.
• Natural light should be used in place of artificial light.
• Lighting levels should be adjusted to the level of detail required and the employee's visual acuity.
• Local lighting, such as spots on the machine, may be necessary to provide higher light levels in critical areas.
• Lighting should be organized to avoid reflections and reflections that can temporarily blind or eliminate employees.
• Lighting should be organized to avoid shadows which can darken areas and create risks.
• Avoid blinking to avoid discomfort and in particular the “stroboscopic effect”
• The lighting must be adapted to the environment (for example intrinsically safe lighting used in a flammable atmosphere).
• Emergency lighting must be present to ensure safety in the event of a power failure.

Protection from exposure to extremes of temperature

First course of action should be eliminated the need for workers to enter the extreme temperature environment. In cases where this is not possible, the environment can be controlled to lower the extreme temperatures. If these options are not possible, other checks should be recommended:

Protection from hot environment:

Ensure ventilation in workplace as moving air gives cooling effect, insulate and/or Shield heat sources, provide easy access to drinking water or isotonic drinks, provide frequent breaks and job rotation, provide appropriate clothing for use in the hot work environment but consideration must be given to other workplace hazards.

Protection from cold environment:

Prevent or protect workers from droughts, shield/lag extremely cold surfaces, provide appropriate PPE viz insulated jackets, trousers, boots, balaclavas, etc., provide frequent breaks and job rotation, provide easy access to hot food and drinks.

In other types of environment, information, instruction, training and supervision should be provided so that workers understand the health consequences of the environment and the early warning signs of problems.

Occupational health center

Medium and large enterprises/ industries those are handling, processing and storing hazardous chemicals and their process may has potential to harm nearby community must setup and maintain onsite occupational health center inside the premises with 24x7 coverage of nurse with occupational health doctors.

Some industries are arranging part-time doctor or through a range of specialists. These specialists are also arranging various training to employees on first Aid and other OH awareness topics. Periodic workplace hygiene survey may also be carried out inline with other exposure survey viz, noise monitoring, illumination, airborne contamination monitoring, etc

Below may be the basic requirement for occupational health center for enterprises upto 50 employees (including workers)

• Company Medical physician on retainer-ship basis must be available in occupational health center to provide his services.
• Medical physician is responsible for carrying or pre-employment medical test and periodic medical test of each employees
• He must ensure the health fitness certificates of all contract workmen
• He must response to any medical emergency in enterprise premises.
• He must ensure availability of at least five trained and competent first aider and assure at least one in every shift.
• He must assure availability of first aid box

Below may be the basic requirement for occupational health center for enterprises having 51 to 200 employees (including workers).

• Room of minimum 15 sq meter floor area with adequate equipment must be available in Occupational Health Center.
• One part-time company medical physician must be available as in charge of the occupational health center and he must visit the company workplace twice in a week.
• Ensure the medical services of this physician must be readily available during medical emergencies
• One competent dresser-cum-compounder must be available in site shift wise.
• First aid box must be available and maintained in all the sections or departments. 

Below may be the basic requirement for occupational health center for enterprises having over 200 employees (including workers).

• Upto 500 workers in enterprise, one permanent full-time medical physician must be appointed
• After every 1000 workers, a medical physician must be added. This physician may be appointed as part time.
• There must be at least two rooms of 15 sq feet floor area each with adequate medical testing equipment.
• Other than physician, one competent nurse, dresser, compounder and cleaner must be maintained round the shift.
• The Occupier Health Center must have adequate medical equipment including stretcher to handle all type of medical emergencies.
• The enterprise medical physician must be approved occupational specialist and he must possess valid certificate as per country recognized institute.

Below medical equipment may be available and maintained in industrial occupational health center

• A glazed sink with facility of hot and cold water.
•  Minimum 180 cm x 105 cm size table with a smooth top
• sterilizing instruments facility
• A couch.
• Containers with weather proof lids.
• Sanitizer or kettle for boiling water
• 120 ml bottle of spiritus ammoniac aromations
• Sponges.
• At least two “kidney” trays.
• Two clinical thermometers.
• measuring glasses.
• Eye wash solutions/ liquid bottles
• carbolic lotion
• at least 3 chairs 1 screen, hand torch
• Adequate supply of tetanus toxied
• Coramine liquid, Tablets – antihishtaminic, antispasmodic
• Syringes with needles, needle holders, Suturing needles and materials.
• One dissecting forceps.
• Dressing forceps. scaples. stethescope.
• Rubber bandage, pressure bandage.
• Oxygen cylinder with necessary attachments.
• patellar Hammer may be made available along with Blood pressure apparatus and peak-flow meter for measurement of lung function.
• One stomach wash set.
• Pairs artery forceps, Injections-morphia, pethadine, atropine, adrenaline, ceramine, novacan
• Surgical scissors.

Occupational health services

Many small to medium size enterprises tie up with external occupational health providers as and when they need it to support their staff and carry out medicals and other occupational health assessments.

Occupational health services help organization to establish and maintain healthy work environment to preserve the physical and mental state of worker by identifying, analyzing and implementing the control measures over health hazards associated with workplace.

One of the proactive measures is to establish the system of periodic health check up to monitor employee’s health and pre employment medical test must be conducted. Master data for each employee must be maintained to monitor the health or any specific ill-health trend.

Management must support health promotion and education programs, provide advice and counselling to employees around non-health-related problems.

Occupation health services may include

• PME (Periodical Medical Examinations)
• Special medical examination for specific occupational health hazards related to type of company.
• Pre-employment medical examinations to issue the fitness certificate.
• Industrial hygiene and ergonomic survey and encouraging safe working practices.
• Exposure monitoring like, noise survey, illumination survey, hazardous chemical fumes, gas, vapour or dust exposure monitoring and evaluate the workers risk of occupational diseases.
• Training and awareness on occupational health hazards and its prevention, training on ergonomic, etc.
• Organize first aid courses with state or recognized institutes.
• Emergency handling and preserve the life till transportation to specialist hospitals or medical centre.
• Occupational health services may include assisting the management on sickness absence.

Occupational Health Clinic

An occupational health clinic can be established near the industrial area or at the country-state level to provide preliminary health care services to all workers and employees engaged in different types of industrial or commercial work activities. Large-scale industries are generally establishing their occupational health clinic within their facilities and the company township of their employees to provide their employees and workers with preliminary emergency medical treatment and routine medical examinations.

At the state level, also publicly, the local government established an occupational health clinic under the ministry of health to provide primary occupational health services to government employees and other workers.

In some countries, access to the occupational health clinic established by the Ministry of Health does not accept direct requests from the public and private sector directly / individually. They allowed access through the responsible authorities. For more details, you can visit their website or other contact regarding the approach procedure.

Educational qualification requirement for the occupational health doctor

He must be a college master or graduate degree doctor with special training in occupational health from the accredited institute. He must pass the NMBE (National Medical Board Exam) that has a license to practice in public services as a doctor.

Doctors passed from the university and an osteopathic institute and must receive a special training course on occupational health from a recognized institute. He must practice in public health services.

Occupational Health Education

The main objective of occupational health education is to promote the physical, mental and social well-being of workers and prevent occupational diseases in the workplace.

It grants rights to know the health hazards in the workplace, the possible risk factors associated with their work and encourages workers to manage their health individually by making them aware of health problems.

All workers in an organization must be informed about occupational health by a qualified and competent occupational physician / occupational medical officer in the organization.

Occupational health education may include;

• Knowledge about hazardous chemicals handled by workers or stored in the factory premises.
• Display of signs and other information related to hazardous chemicals according to the material safety data sheet (MSDS).
• Education on general health, hygiene and lifestyle at work / outside of work and creation of an individual health plan.
• Importance of a healthy diet and physical activities.
• Education about pulse controls and blood pressure.
• Education about cholesterol (LDL / HDL), glucose tests, blood sugar tests and other blood tests.
• Bone Density Testing / Osteoporosis Detection
• Education in arterial hypertension and electrocardiogram (ECG)
• Education on measuring body mass index (BMI)
• Education on general health issues, including stress and a healthy posture.
• Education about skin diseases, weight control and smoking addictions.
• Education in audiometry evaluation.
• Education about the sense of joint position and the sense of vibration

Bachelor of Occupational Health education

Institutes recognized by the government and private are conducting courses in occupational health education. As occupational health is also associated with the safety profession, most courses are held under the title "Bachelor of Occupational Health and Safety".

Here is the list of degree courses related to occupational health that are conducted full-time and part-time.

Sr. No.	Course Title	Degree/ Diploma	Part/Full time	NQFL	Duration
1	Bachelor of Occupational Health and Safety	Degree	Part-time	Level-6	5 years
2	Bachelor of Science in Occupational Therapy	Degree	Full-time	Level-6	4 years
3	Occupational Health Psychology	Degree	Part-time	Level-6	4 years
4	MSc Occupational Health & Safety Management	Degree	Part-time	Level-6	2 years
5	Occupational Health Safety and Environment MSc	Degree	Part-time	Level-6	2 years
6	Occupational Health Psychology Professional Doctorate	Degree	Part-time	Level-6	4 years
7	Occupational Health and Safety Management MSc	Degree	Part-time	Level-6	3 years
8	Occupational Health, Safety and Environmental Management MSc	Degree	Part-time	Level-6	3 years

Below are the top 10 courses on occupational health and safety

1. Environmental Science Safety, BS: conducted by The University of Houston- Clear Lake, Houston, Texas,
2. Industrial Hygiene BA/BS: Conducted by University of North Alabama,
3. Occupational Safety & Health Management, BS: Conducted by Grand Valley State University
4. Public Health, Emphasis: Industrial Hygiene, BS: Conducted by Utah State University 
5. Occupational and Environmental Hygiene, BS: Conducted by The Johns Hopkins University
6. Industrial Hygiene, BS: Conducted by Ohio University
7. Occupational Safety and Health, BS: Conducted by University of Central Missouri 
8. Occupational Safety and Health, BS: Conducted by Oakland University 
9. Occupational Health Sciences, BS: Purdue University at West Lafayette
10. Occupational Safety and Health, BS: Conducted by Montana Tech of the University of Montana

Occupational health degree online

Here is the list of online degree courses related to occupational health conducted by national accreditation agencies.

Sr. No.	Course Title	Degree/ Diploma	University	Duration
1	Occupational Health and Safety Management MSc	Degree	University of Portsmouth	2 years
2	Occupational Health, Safety and Environmental Management MSc	Degree	University of Portsmouth	2 years
3	Occupational Health and Safety Management	PG certificate	University of Portsmouth	1 year
4	Occupational Health and Safety Management	Degree	University of Hull partnership with NEBOSH	2 years
5	MSc in Occupational Health	Degree	Cardiff University	3 years

Other top 5 distance online courses on occupational health are;

1. PG Diploma: Specialist Community Public Health Nursing (Occupational Health) - PGDip: Conducted by University of the West of Scotland.
2. MSc: Occupational Health (Policy and Practice): Conducted by Cardiff University
3. MSc: Public Health and Health Promotion: Robert Gordon University
4. MSc/PGDip/PGCert Occupational Hygiene; Conducted by The University of Manchester
5. MSc: Occupational Health: University College Cork 

There are several institutes that offer online courses worldwide on occupational health, you can search online. The most reputable are NEBOSH and IOSH.

Conclusion

We have studied about what is difference between Health and occupational health. The main objective of occupational health and Importance of occupational health is to protect and promote the health of worker/employees. Work environment should be maintained for prevention of occupational diseases by ensuring cleanliness, adequate engineering and administrative work practices. The main five Occupational health hazards ie. Physical, chemical, biological, psychological and mechanical must be controlled by implementing good occupational health management system. we now clear about ill-health or occupational disease is Identifiable, adverse physical or mental condition arising from and / or made worse by a work activity. Occupational health management system must be developed, implement and maintained to prevent occupational diseases by encouraging safe and healthy working practices and providing healthy work environment.

Occupational health program is multidisciplinary plan developed for preventing the occupational diseases or illness by continuous monitoring of workplace, early identification, evaluation and controlling the work-related health hazards. Medium and large enterprises/ industries those are handling, processing and storing hazardous chemicals and their process may has potential to harm nearby community must setup and maintain onsite occupational health center inside the premises. An occupational health clinic can be established near the industrial area or at the country-state level to provide preliminary health care services to all workers and employees engaged in different types of industrial or commercial work activities. General requirement for occupational health doctor is that he must be a college master or graduate degree doctor with special training in occupational health from the accredited institute. 

The main objective of occupational health education is to promote the physical, mental and social well-being of workers and prevent occupational diseases in the workplace.

Occupational health services help organization to establish and maintain healthy work environment to preserve the physical and mental state of worker by identifying, analyzing and implementing the control measures over health hazards associated with workplace. Proactive measures viz, periodic medical examination, health campaign and health education must be provided. Ensure pre employment medical test, routine hygiene survey and workplace sampling. All these measures may assure workplace is free from any diseases/ ill-health.

As occupational health is also associated with the safety profession, most courses are held under the title "Bachelor of Occupational Health and Safety". list of online degree courses related to occupational health conducted by national accreditation agencies is readily available in internet.

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